Navigating A Path to Success

Chiropractic EconomicsJanuary 7, 2000

Dr. Carol Ann Malizia knows where she’s been. She also knows where she wants to go, and has a pretty good idea of how she’s going to get there. More than just meandering from Point A to B, she’s working in a straight line. Malizia has relied on a strong sense of direction and some solid guides to navigate the ever-changing terrain of chiropractic.As founder of the Chiropractic Health Center in Walden, N.Y. (about 90 minutes north of Manhattan), Malizia has forged a path to become the owner of a thriving practice with gross billings of “more than $500,000” per year. With a staff of eight, including Malizia and associate chiropractor Dr. Vincent Justino, the Chiropractic Health Center boasts 450-500 patient visits per week, with 28-30 new patients each month.

The practice can lay claim to a collection rate of 101%. Malizia attributes this stellar figure to her staff’s diligence in collecting outstanding debt, including interest. A combination of current and past-due collections translates into a balance exceeding 100%. “I have a tenacious staff that doesn’t take ‘no’ for an answer,” Malizia says. “They are so diligent, they will even collect back debt from 1996.” In 1992, the first year the practice was open, the collection rate was in the 87%-88% range. By 1998, it had reached 92%-93%, and by last year the numbers (gross billings vs. total amount collected) surpassed 100%.

“The practice has grown as the result of concepts in marketing and communication,” Malizia says. She doesn’t spend a lot of money on traditional print advertising; a small Yellow Pages ad is about the extent of it. Malizia focuses her marketing efforts elsewhere, making sure her strikes are swift and precise (see related article, this page ). Her greatest expenses center around bi-annual dinners that feature speakers from The Masters, the chiropractic consulting firm based in a suburb of Long Island, N.Y. Malizia recognizes the importance of patient retention. She says her patient visit average (PVA) stands at about 66. Last year, it even bobbed into the 70s.

Practice Strategies

Malizia uses Chiropractic Clipping Service, a collection of chiropractic- related press clippings offered by Dr. Bob Hoffman, as a retention tool. The service, based in the Long Island area, specializes in information aimed at educating people about chiropractic. Patients can read the information in the waiting room, exposing them to trends and developments within the profession. They can read articles that appeared in mainstream magazines and newspapers, such as USA Today, rather than clinical journals.

One of Malizia’s main focal points has been mothers, whom she seems to view as the decision-makers in most families.

“Mothers really control the economics of a family,” she says. “If you start to show mothers the benefits of chiropractic, getting healthy without drugs, they’ll say: ‘This is what I could do to be a better mom.’ ” In keeping with that philosophy, Malizia has compiled a list of mothers in the community who have been successful patients and uses them as de facto recruiters. About 12% of Malizia’s patients are children, a number she would like to see increase to about 30%.

As far as overall practice growth, Malizia would like to see at least a 15% increase during the next 12 to 18 months.

Ancillary Products and Services

Once patients enter the practice, an educational process begins. Malizia promotes the idea of natural healing as a life-long process. This is where ancillary products and services come in. Primarily through orthotics and nutrition, Malizia has been able to help her patients and thrive financially despite challenges from managed care and government regulations. In all, Malizia estimates that as much as 10% of her income comes from ancillary products and services, a number she says is growing.

Through the use of orthotics in general, Foot Levelers in particular, Malizia has been able to educate patients about the importance of a well-functioning nervous system. “Foot Levelers is like Nordstrom’s when it comes to service,” she says. Malizia also stresses the value of chiropractic adjustment and therapy.

Orthotics aren’t introduced right away into a patient’s care. Sometimes, Malizia may even wait until after 12-18 visits. From that point, orthotics are introduced as needed, and a nutritional plan is developed.

“The basics are addressed right off the bat,” Malizia says. “The patient must understand the healing process. The end point is what makes sense to the patient. If they don’t want their health to deteriorate, they’ll see the value of orthotics.”

Foot Levelers president Kent Greenawalt explains: “The feet are the foundation of the pelvis and spine and are critical in helping adjustments hold. Problems in the feet are transferred to the spine and the rest of the body.” He says Foot Levelers’ orthotics “eliminate those problems and as a result, adjustments hold better.”

Malizia retails a variety of other products in her practice. She emphasizes the importance of good nutrition with her patients, and she carries nutritional product lines from Metagenics and Standard Process.

“For a long time, I was a straight practitioner,” Malizia says. “I only recently got involved (with outside products). Now I would advise anybody to get involved…. It’s win, win, win.”

During the next five years, Malizia plans to continue creating a holistic health center where patients can receive structural and nutritional support, as well as additional services such as acupuncture. She would also like to add another chiropractor to her staff during that time frame. “I believe in a practice that’s an outlet where people can learn, and where well care is emphasized instead of sick care,” she says.

Service With A Smile

The growth of Malizia’s practice can also be attributed to an attitude that comes down to service with a smile. By making patients feel at home, Malizia and her staff create a family-type atmosphere. On Tuesdays, the smell of their baking is a tradition patients look forward to. Malizia says her staff are enthusiastic and upbeat, and well-coached in how to meet and greet.

“We role-play constantly,” Malizia says. “There’s a way to ask a patient to settle his balance. It has to do with eye contact and how they say what they say. They’ve learned that and cultivated that.”

That’s just one of the many strategies Malizia has learned from The Masters. Malizia and her entire staff attend team-training seminars at least four times a year. The seminars re-energize them and provide lots of new ideas.

Mentor Dr. Larry Markson, co-founder and owner of The Masters, has emphasized to Malizia the importance of being a good business person as well as a good chiropractor.

“She’s built a significant practice,” Markson says of Malizia. “She does it by being a charismatic, energized chiropractor, committed to getting patients well naturally. She’s a walking, talking, living billboard for what chiropractic should be.”

Little Things That Mean A Lot

Malizia is a big advocate of staying involved in her patients’ lives. That includes gestures as simple as sending cards and notes to patients, all the way up to observing in the operating room during patients’ surgeries. Malizia keeps in touch with patients’ medical doctors to help keep tabs on their overall health. This can be a big task, with more than 2,000 patient visits during some months, but Malizia says it’s worth it. Having a positive relationship with other doctors is nearly as important as having a good relationship with the patients themselves, Malizia says. “We’ve started by having a good rapport with radiologists, sending them films they might find interesting, that type of thing.” Oftentimes, she says, MDs/DOs “are taken aback by how interested we are in the patients’ care.”

This all goes back to Malizia’s philosophy of spending more energy than money when it comes to promoting herself, her practice and her profession. Staying involved in people’s lives, she says, is as important as staying visible to the general public. “You have to be focused,” she says. “You decide to. You make a decision that it’s what you want. It makes me happy because I know that I’m affecting people’s lives.”

Malizia adds: “It’s tremendously important to be present in the community.”

For Malizia, being visible in the community includes an active interest in athletics, such as youth and adult soccer leagues. Introducing young athletes to chiropractic, Malizia says, is every bit as important as introducing it to middle-aged or older, sedentary people. “If we don’t educate younger athletes, nobody else is going to do it. When you start to educate the younger adults that their body has the ability to heal itself, you’re instilling in them tremendous values of respecting their bodies.”

Malizia says she has improved herself as both a practitioner and a person by establishing relationships with people as successful as herself or more so. That led her to The Masters and Markson, with whom she has worked for seven years. Now it’s likely others will look to Malizia, the Masters’ 1997 Chiropractor of the Year, as a role model.

She has succeeded by constantly thinking of ways to grow and improve, and by not being afraid to fail. “People get frustrated in their practice and wind up chasing their tails,” she says. “If you’re stagnant, you’re kind of like white bread and mayonnaise. It’s not necessarily a financial thing, either, Practices are built on building relationships.”

Relationship-building has been one of the biggest factors in Malizia’s success, Markson says. “She loves people and people love her,” he explains. “She’s just tremendous.”

Savvy Marketing Strategies That Bring In $4 For Every $1 Spent

For Dr. Carol Ann Malizia, one key to avoiding famine has been the feast. Malizia’s biggest marketing boon is the practice’s “internal dinners,” held twice yearly. Malizia has used the dinners as a public relations tool to make the practice visible to the entire community, especially prospective patients. The dinners have also gone a long way toward patient retention for Malizia’s half-a-million-dollar-plus practice in upstate New York.

The dinners are attended by as many as 70 people at $10-12 per person. Malizia uses the get-togethers as an opportunity to introduce people to chiropractic in a fun and low-stress environment. Of 50 people at a recent dinner, 22 were non-patients, and 18 ended up becoming new patients. That type of response rate makes the time and energy that go into the dinners well worth it, Malizia says. “Any investment you make internally, you should bring back at least four-fold of what you invest,” she says.

Part of the spin at the dinners is having prospective patients learn about chiropractic from someone other then Malizia. The dinners always feature a speaker from The Masters, the chiropractic consulting firm based in a suburb of Long Island, N.Y. The emphasis on outside speakers eliminates the appearance of sheer recruiting. “Patients love to hear it from a different mouth,” Malizia says. “It’s a new influence.” Malizia also addresses the group briefly at each dinner, making clear some of the services available at her practice.

Beyond the dinners, Malizia gets involved in the community at events such as Kids Day America. She also offers patient education workshops. Malizia has a small ad in the Yellow Pages, but relies more strongly on word-of-mouth. “I have a strong belief in internal referrals,” she says. “We tell people on the second visit what we expect of them as patients. We expect them to follow through with our recommendations and to tell others about chiropractic.”

That strategy, along with “anything that gets us directly involved with the immediate community,” has resulted in a practice that sees 28-30 new patients per month and 450-500 total patient visits each week — 2 1/2 times more than when Malizia opened her doors in 1992.

Malizia’s goal from a marketing standpoint is to bring in four dollars for every dollar she spends. It’s a concept espoused by The Masters, and one she has adhered to stringently. With the internal dinners, she has easily been able to trace the success level of her marketing efforts.

A recruiting strategy Malizia uses at the dinners is to offer the “guests” a discounted visit, which includes a spinal scan done via Insight 7000TM, a software program developed by the Chiropractic Leadership Alliance. This tool allows new patients to quickly see evidence of the advantages of chiropractic, and it can also be repeated once prospects become patients, to monitor their progress.

“Mostly at the dinners, we’ll give them a lay lecture about chiropractic,” explains Malizia. “We tie it into a holistic approach of health and well-being.”